“That’s Like an Act of Suicide” Patients’ Attitudes Toward Deactivation of Implantable Defibrillators
To understand potential patient barriers to discussions about implantable cardioverter defibrillator (ICD) deactivation in patients with advanced illness.
Qualitative focus groups.
Fifteen community-dwelling, ambulatory patients with ICDs assigned to focus groups based on duration of time since implantation and whether they had ever received a shock from their device.
A physician and a social worker used a predetermined discussion guide to moderate the groups, and each session was audiotaped and subsequently transcribed. Transcripts were analyzed using the method of constant comparison.
No participant had ever discussed deactivation with their physician nor knew that deactivation was an option. Patients expressed a great deal of anxiety about receiving shocks from their device. Participants discussed why they needed the device and expressed desire for more information about the device; however, they would not engage in conversations about deactivating the ICD. One patient described deactivation “like an act of suicide” and all patients believed that the device was exclusively beneficial. Patients also expressed a desire to have their physician make the decision about deactivation.
None of the patients in our study knew that they might need to deactivate their ICD as their health worsens. These community-dwelling outpatients were not willing to discuss the issue of ICD deactivation and their attitudes about deactivation might impede patients from engaging in these conversations. These findings are in contrast to findings in other advance care planning research and may be related to the unique nature of the ICD.
- Buxton AE, Lee KL, Fisher JD, Josephson ME, Prytowsky EN, Hafley G. A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med. 1993;341(25):1882–90. CrossRef
- Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225–37. CrossRef
- Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med. 1996;335(26):1933–40. CrossRef
- Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83. CrossRef
- Glikson M, Friedman PA. The implantable cardioverter defibrillator. Lancet. 2001;357:1107–17. CrossRef
- Eckert M, Jones T. How does an implantable cardioverter defibrillator (ICD) affect the lives of patients and their families? Int J Nurs Pract. 2002;8:152–7. CrossRef
- Sears SF, Conti J. Quality of life and psychological functioning of ICD patients. Heart. 2002;87:488–93. CrossRef
- Goldstein NE, Lampert R, Bradley EH, Lynn J, Krumholz HM. Management of implantable cardioverter defibrillators in end-of-life care. Ann Intern Med. 2004;141:835–8.
- Kadish A, Dyer A, Daubert JP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004;350(21):2151–8. CrossRef
- Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–50. CrossRef
- Gillick MR. Medicare coverage for technological innovations—time for new criteria? N Engl J Med. 2004;350(21):2199–203. CrossRef
- Brown D. Medicare to cover heart devices. The Washington Post 2003, June 7, A04.
- Hlatky MA, Sanders GD, Owens DK. Evidence-based medicine and policy: the case of the implantable cardioverter defibrillator. Health Aff (Millwood). 2005;24(1):42–51. CrossRef
- Sofaer S. Qualitative methods: what are they and why use them? Health Serv Res. 1999;34(5 Pt 2):1101–18.
- Sofaer S. Qualitative research methods. Int J Qual Health Care. 2002;14(4):329–36. CrossRef
- Strauss A, Corbin JM. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks: SAGE Publications, Inc.; 1998.
- Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23(10):433–41.
- Dunbar SB. Psychosocial issues of patients with implantable cardioverter defibrillators. Am J Crit Care. 2005;14(4):294–303.
- Irvine J, Dorian P, Baker B, et al. Quality of life in the Canadian implantable defibrillator study (CIDS). Am Heart J. 2002;144(2):282–9.
- Strauss A, Corbin JM. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. 2nd Edition. San Francisco: Sage Publications; 1990.
- Glaser B, Strauss A. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine Publishing Company; 1967.
- Patton MQ. Qualitative Research & Evaluation Methods. San Francisco: Sage Publications; 2001.
- Schulman-Green DJ, Naik AD, Bradley EH, McCorkle R, Bogardus ST. Goal setting as a shared decision making strategy among clinicians and their older patients. Patient Educ Couns. 2006;63(1–2):145–51. CrossRef
- Morrison RS, Chichin E, Carter J, Burack O, Lantz M, Meier DE. The effect of a social work intervention to enhance advance care planning documentation in the nursing home. J Am Geriatr Soc. 2005;53(2):290–4. CrossRef
- Degner LF, Sloan JA. Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol. 1992;45(9):941–50. CrossRef
- Davison BJ, Kirk P, Degner LF, Hassard TH. Information and patient participation in screening for prostate cancer. Patient Educ Couns. 1999;37(3):255–63. CrossRef
- Heyland DK, Tranmer J, O’Callaghan CJ, Gafni A. The seriously ill hospitalized patient: preferred role in end-of-life decision making? J Crit Care. 2003;18(1):3–10. CrossRef
- Heyland DK, Frank C, Groll D, et al. Understanding cardiopulmonary resuscitation decision making: perspectives of seriously ill hospitalized patients and family members. Chest. 2006;130(2):419–28. CrossRef
- Voigt A, Ezzeddine R, Barrington W, et al. Utilization of implantable cardioverter-defibrillators in survivors of cardiac arrest in the United States from 1996 to 2001. J Am Coll Cardiol. 2004;44(4):855–8. CrossRef
- Davis DR, Tang AS, Lemery R, Green MS, Gollob MH, Birnie DH. Influence of gender on ICD implantation for primary and secondary prevention of sudden cardiac death. Europace. 2006;8(12):1054–6. CrossRef
- Fried TR, Bradley EH, O’Leary J. Prognosis communication in serious illness: perceptions of older patients, caregivers, and clinicians. J Am Geriatr Soc. 2003;51(10):1398–403. CrossRef
- Goldstein NE, Concato J, Bradley EH, O’Leary J, Fried TR. Doctor–patient communication about prognosis: the influence of race and financial status. J Palliat Med. 2005;8(5):998–1004. CrossRef
- “That’s Like an Act of Suicide” Patients’ Attitudes Toward Deactivation of Implantable Defibrillators
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of General Internal Medicine
Volume 23, Issue 1 Supplement, pp 7-12
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- palliative care
- advanced technology
- patient–physician relationship
- implantable cardioverter defibrillator
- Industry Sectors
- Author Affiliations
- 1. Department of Geriatrics, Mount Sinai School of Medicine, Box 1070, One Gustave Levy Place, New York, NY, 10029, USA
- 2. Geriatric Research Education and Clinical Care Center, James J. Peters Veterans Affairs Health System, Bronx, New York, NY, USA
- 3. Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
- 4. Department of Epidemiology and Public Health and Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA